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Objective: To determine the frequency of early and late labour induction in premature rupture of membranes and compare their outcome. Study Design: Cross sectional study. Place and Duration of Study: Department of Obstetrics & Gynaecology, Combined Military Hospital, Rawalpindi Pakistan,from Jan-Dec 2021. Methodology: One hundred and sixty-four pregnant women aged 18-35 years, with uncomplicated pregnancies at gestational age ≥37 weeks to ≤40 weeks with premature rupture of membranes, were included. All primigravida and multiparous with previous normal vaginal deliveries were selected. Patients were selected with reactive CTG, adequate pelvis, clear liquor and vertex presentation. Induction of labour achieved with cervical Prostaglandin E2. Labour was monitored accordingly. Results: Seventy-four women (45%) presented (and got induction of labour) within 12 hours of premature rupture of membranes (early induction of labour), while 90(55%) fell under late induction of labour. 35(21%) were delivered by instrumental vaginal delivery, while 31(19%) were delivered by caesarian section. The most common indication of the caesarian section was fetal distress (36%), followed by poor progress of labour (32%). Patients with early induction of labour witnessed less chorioamnionitis (7% vs 18%) and post-partum haemorrhage (8% vs 13%). Likewise, with early induction of labour incidence of neonatal sepsis was less (3% vs 10%) with limited poor APGARs at birth (3% vs 12%). No early neonatal death was observed in 164 cases. Conclusion: For women with term premature rupture of membranes, earlier induction of labour results in lower maternal and fetal morbidity.

Objective: To compare the outcome of Salbutamol nebulization with normal saline (placebo) in transient tachypnea of the newborn. Study Design: Comparative prospective study. Place and Duration of Study: Department of Neonatal Medicine, Military Hospital Rawalpindi, from Jan 2017 to Mar 2018. Methodology: Sixty term neonates with respiratory rate >60 breaths/min and transient tachypnea of newborn score of ≥4 were enrolled. They were randomly allocated to two equal groups. Group-1 received Salbutamol nebulization (0.15 mg/kg) while Group-2 received normal Saline (placebo) nebulization. Results: The mean gestational age was 38.31±1.28 weeks, while the average birth weight was 2.97±0.27 kg. The mean change in transient tachypnea of newborn score with Salbutamol nebulization was 5.63±1.22, while 0.63±1.54 with normal Saline nebulization. Likewise, the mean change in respiratory rate with Salbutamol was 9.80±2.05, while -3.73±2.57 with normal saline. Conclusion: This study demonstrated nebulized Salbutamol as an effective tool in reversing transient tachypnea of newborns with decreasing respiratory rate compared to normal saline nebulization (placebo).

Objective: To assess efficacy of salbutamol delivered through metered dose inhaler (MDI) - spacer in paediatric patients with acute exacerbation of asthma. Study Design: Prospective observational study. Place and Duration of Study: Department of Paediatrics, Pakistan Naval Ship, Shifa Hospital, Karachi-Pakistan, from Jan to Dec 2018. Methodology: Ninety Five patients aged ≥6 to ≤12 years, with acute asthma exacerbation were enrolled. Any patient with fever, clinical asthma score (CAS) >7, on home treatment with drugs delivered through nebulization or on oral steroids was excluded. Clinical asthma score recorded on presentation, followed with salbutamol via Metered Dose Inhaler & spacer at dose of 400 µgm (4 x puffs of 100 µgm). Clinical asthma score rechecked after 20 min. Response to salbutamol was then compared in relation to the presenting Clinical asthma score. Results: Out of 95 children, 45 (47.9%) were male & 50 (52.1%) female with 67.4% having positive family history for asthma. Average premedication clinical asthma score was 2.44. Sixty nine (72.9%) patients had an adequate response as they exhibited clinical asthma score of 0 or fall in score of ≥2. Patients with adequate response had average clinical asthma score of 2.07 on presentation in contrast to 3.42 with inadequate response. Conclusion: Salbutamol delivered via Metered Dose Inhaler & spacer at dose of 400 µgm is an effective medication for quick relief in children with acute exacerbation of asthma. Moreover, its administration at a point where exacerbation is not much severe steers us towards more favourable outcome.

Objective: To study the prevalence and the pattern of distribution of congenital heart disease. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted at outpatient department (OPD) of CMH Chhor and DHQ Umerkot, Sindh (Pakistan), from Dec 2019 to Mar 2020. Methodology: All the children (